Primary Hyperparathyroidism
Most of us have four parathyroid glands, residing in the neck near the thyroid gland. They possess sensors which monitor calcium levels in the blood, and produce parathyroid hormone to maintain healthy blood calcium levels, necessary for normal nerve and muscle function. In the condition of primary hyperparathyroidism, too much hormone is released, resulting in elevation of blood calcium by removing calcium from the bones. Over time this causes osteoporosis and fractures, as well as risking kidney stones due to all the calcium being filtered through the kidneys.
When the condition of Primary Hyperparathyroidism was first identified, patients were afflicted with broken bones from osteoporosis and with kidney failure due to kidney stones causing blockage and infection.
Today it is more likely that your referring doctor has made the diagnosis based on a blood test organised as part of a routine health check or for an unrelated reason. In this situation, we offer surgery to prevent damage to your bones and kidneys before they have time to be affected.
Apart from protecting you from osteoporosis and kidney stones, removal of an overactive parathyroid gland, referred to as a parathyroidectomy, may improve energy levels and muscle strength, reduce general aches and pains, and improve cognitive function such as memory, concentration and clarity of thinking. These are non-specific symptoms which can be due to other factors in your life, so there is no guarantee of a noticeable change, but many patients report a definite improvement in quality of life after treatment.
Pre-operative localisation studies
Sometimes two or more parathyroid glands are abnormal, but in 90% of cases, only one of the four parathyroids is overactive. We can often identify which one is the dysfunctional gland by performing a parathyroid nuclear scan, known as a Sestamibi scan, a neck ultrasound, or a 4D CT (Four dimensional CT scan). However, about 20% of the time the tests are “negative” or unhelpful. If the scans do not reveal the problematic parathyroid gland, surgery is still recommended, but a bilateral (four gland) exploration is required, and the expected cure rate remains over 95%.
Surgical techniques
- Minimally invasive (targeted) parathyroidectomy
This method is used when the localisation studies indicate which one of the four parathyroid glands has become enlarged and overactive. A small incision is made, the dysfunctional gland is removed, and the others are not disturbed. The cure rate under these circumstances is over 95%. - Bilateral exploration
When it is not known which gland is abnormal, all four glands are located and inspected, with all large ones being removed, which in most cases will only be one or two of them. This generally requires a slightly longer surgical incision but is still very cosmetically acceptable in the vast majority of cases.
To help understand what your experience may be like as a patient, please peruse Patient Information written by Dr Wilkinson for this website.